The Prognostic Role of Serum Procalcitonin for Adult Patients with Acute Diarrhea in the Emergency Department.

IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Antonella Gallo, Marcello Covino, Eleonora Ianua', Andrea Piccioni, Davide Della Polla, Benedetta Simeoni, Francesco Franceschi, Francesco Landi, Massimo Montalto
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Abstract

Background. Acute diarrhea is one of the leading causes of Emergency Department (ED) access. The search for the causative pathogen cannot be routinely performed since conventional methods, like stool cultures, are time-consuming, requiring days for growth and delaying diagnosis and the start of therapy. In this large sample retrospective study, we evaluated the prognostic role of serum procalcitonin (PCT) for adult patients with acute diarrhea in the ED. Methods. In a retrospective, mono-centric study, we enrolled all patients visiting our ED complaining of acute diarrhea and then hospitalized over five years. Final diagnosis of an infective (including bacterial) diarrhea, any other infection, and a bloodstream infection (BSI) was collected by clinical records, according to the International Disease Classification 10th edition. Procalcitonin determination was obtained upon request of the ED physician at the admission visit based on patient evaluation and clinical judgment. Results. Of a total of 1910 patients, early PCT values (cut-off of 0.5 ng/mL) did not show a significant predictive value for infective diarrhea (OR 0.554 [0.395-0.778]), nor for bacterial diarrhea (OR 0.596 [0.405-0.875]). Conversely, PCT levels at ED admission showed a significant predictive value for a final diagnosis of any infection (OR 1.793 [1.362-2.362]) and, above all, of bloodstream infection (BSI) (OR 6.694 [4.869-9.202]). Conclusions. Our data suggest that in ED, where the complexity and heterogeneity of patients are very high, indiscriminate PCT-guided management of patients with diarrhea is not indicated. Conversely, in patients with diarrhea but also clinical suspicion of BSI, PCT determination remains a useful instrument, possibly improving clinical management.

急诊科急性腹泻成人患者血清降钙素原的预后作用。
背景。急性腹泻是急诊科(ED)访问的主要原因之一。寻找致病病原体不能常规进行,因为粪便培养等传统方法耗时,需要数天的生长时间,延误了诊断和治疗的开始。在这项大样本回顾性研究中,我们评估了血清降钙素原(PCT)在急诊科急性腹泻成年患者中的预后作用。在一项回顾性的单中心研究中,我们招募了所有来急诊科抱怨急性腹泻并住院5年以上的患者。根据国际疾病分类第10版,通过临床记录收集感染性(包括细菌性)腹泻、任何其他感染和血液感染(BSI)的最终诊断。降钙素原测定是应急诊医生的要求,根据患者的评估和临床判断进行的。结果。在总共1910例患者中,早期PCT值(截止值为0.5 ng/mL)对感染性腹泻(OR为0.554[0.395-0.778])和细菌性腹泻(OR为0.596[0.405-0.875])均未显示出显著的预测价值。相反,入院时的PCT水平对任何感染的最终诊断(OR为1.793[1.362-2.362]),尤其是血液感染(BSI)的最终诊断(OR为6.694[4.869-9.202])具有显著的预测价值。结论。我们的数据表明,在急诊科,患者的复杂性和异质性非常高,不建议对腹泻患者进行不加区分的pct指导管理。相反,对于腹泻但临床怀疑BSI的患者,PCT检测仍然是一个有用的工具,可能改善临床管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Diagnostics
Diagnostics Biochemistry, Genetics and Molecular Biology-Clinical Biochemistry
CiteScore
4.70
自引率
8.30%
发文量
2699
审稿时长
19.64 days
期刊介绍: Diagnostics (ISSN 2075-4418) is an international scholarly open access journal on medical diagnostics. It publishes original research articles, reviews, communications and short notes on the research and development of medical diagnostics. There is no restriction on the length of the papers. Our aim is to encourage scientists to publish their experimental and theoretical research in as much detail as possible. Full experimental and/or methodological details must be provided for research articles.
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